Risk Factors for the Development of Postoperative Delirium in Pediatric Intensive Care Patients

Meyburg, Jochen; Dill, Mona-Lisa; Haken, Rebecca von; Picardi, Susanne; Westhoff, Jens H.; Silver, Gabrielle; Traube, Chani

doi:10.1097/pcc.0000000000001681

Cited by 35 publications

(42 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in the context of postoperative delirium in the PICU, we could recently show that fentanyl increases the risk for delirium in a dose-dependent way and that this could probably be attributed to substance-specific anticholinergic effects. 21 Therefore, it would be very interesting to see the results of the 322 patients from the three unpublished registered trials (NCT02753725, 22 NCT03010540, 23 NCT03062488) 24 on intraoperative fentanyl given at different doses.…”

Section: Discussionmentioning

confidence: 99%

Publication bias in pediatric emergence delirium: a cross-sectional analysis of ClinicalTrials.gov and ClinicalTrialsRegister.eu

Meyburg

Ries

2020

BMJ Open

Self Cite

View full text Add to dashboard Cite

ObjectivesEmergence delirium (ED) is a frequent and potentially serious complication of general anaesthesia in children. Although there are various treatment strategies, no general management recommendations can be made. Selective reporting of study results may impair clinical decision-making. We, therefore, analysed whether the results of completed registered clinical studies in patients with paediatric ED are publicly available or remain unpublished.DesignCross-sectional analysis.SettingClinicalTrials.gov and ClinicalTrialsRegister.eu.Participants and outcome measuresWe determined the proportion of published and unpublished studies registered at ClinicalTrials.gov and ClinicalTrialsRegister.eu that were marked as completed by 1st September 2018. The major trial and literature databases were used to search for publications. In addition, the study investigators were contacted directly. For published trials, time to publication was calculated as the difference in months between study completion date and publication date.ResultsOf the 44 registered studies on paediatric ED, only 24 (54%) were published by September 2019. Published trials contained data from n=2556 patients, whereas n=1644 patients were enrolled in unpublished trials. Median time to publication was 19 months. Studies completed in recent years were published faster, but still only 9 of 24 trials were published within 12 months of completion.ConclusionThere is a distinct publication gap in clinical research in paediatric ED that may have an impact on meta-analyses and clinical practice.

show abstract

Section: Discussionmentioning

confidence: 99%

Publication bias in pediatric emergence delirium: a cross-sectional analysis of ClinicalTrials.gov and ClinicalTrialsRegister.eu

Meyburg

Ries

2020

BMJ Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…Minimizing pain with intraoperative Fentanyl given at a mean dose of 2.5 µg/kg at the end of surgery reduced the incidence of ED in a study by Cohen et al 13 . However, in the context of postoperative delirium in the PICU we could recently show that fentanyl increases the risk for delirium in a dose-dependent way and that this could probably attributed to substance-specific anticholinergic effects 14 . Therefore it would be very interesting to see the results of the 322 patients from the three unpublished registered trials (NCT02753725, NCT03010540, NCT03062488) on intraoperative fentanyl given at different doses.…”

Section: Discussionmentioning

confidence: 99%

Unpublished clinical studies in pediatric emergence delirium – a cross sectional analysis

Meyburg

Ries

2020

Preprint

Self Cite

View full text Add to dashboard Cite

Objectives: Emergence delirium (ED) is a frequent and potentially serious complication of general anesthesia in children. Although there are various treatment strategies, no general management recommendations can be made. Selective reporting of study results may impair clinical decision making. We therefore analyzed whether the results of completed registered clinical studies in patients with pediatric ED are publically available or remain unpublished. Design: cross sectional analysis Setting: ClinicalTrials.gov and ClinicalTrialsRegister.eu Participants and outcome measures: We determined the proportion of published and unpublished studies registered at ClinicalTrials.gov and ClinicalTrialsRegister.eu that were marked as completed by September 1st 2018. The major trial and literature databases were used to search for publications. In addition, the study investigators were contacted directly. Results: Of the 44 registered studies on pediatric ED, only 24 (54%) have been published by September 2019. Published trials contained data from n=2556 patients, whereas n=1644 patients were enrolled in unpublished trials. Median time to publication was 19 months. Studies completed in recent years were published faster, but still only 9 of 25 trials were published within 12 months after completion. Conclusion: There is a distinct publication gap in clinical research in pediatric ED that may have an impact on clinical practice.

show abstract

“…[ 23 ] Another single-center prospective cohort study found that nearly 66% children were delirious after major surgery in pediatric intensive care unit (PICU). [ 19 ] This may be explained by following aspects. First, we focused on all children after major elective surgery rather than critically-ill children in PICU.…”

Section: Discussionmentioning

confidence: 99%

“…Putative risk factors for delirium development were extrapolated from a review of the pediatric and adult literature in medical and surgical patients. [ 19 ] Preoperative data collected included: sleep duration, fluid fasting time, severity of parental anxiety using Hamilton Anxiety Scale. [ 20 ] Intraoperative data collected included: length of anesthesia, length of surgery, and blood loss.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of a postoperative delirium prediction model for pediatric patients

Lin¹,

Liu²,

Feng³

et al. 2021

Medicine

View full text Add to dashboard Cite

Postoperative delirium is a serious complication that relates to poor outcomes. A risk prediction model could help the staff screen for children at high risk for postoperative delirium. Our study aimed to establish a postoperative delirium prediction model for pediatric patients and to verify the sensitivity and specificity of this model. Data were collected from a total of 1134 children (0–16yr) after major elective surgery between February 2020 to June 2020. Demographic and clinical data were collected to explore the risk factors. Multivariate logistic regression analysis was used to develop the model, and we assessed the predictive ability of the model by using the area under the receiver operating characteristics curve (AUROC). Further data were collected from another 100 patients in October 2020 to validate the model. Prevalence of postoperative delirium in this sample was 11.1%. The model consisted of 5 predictors, namely, age, developmental delay, type of surgery, pain, and dexmedetomidine. The AUROC was 0.889 ( P < .001, 95% confidence interval (CI):0.857–0.921), with sensitivity and specificity of 0.754 and 0.867, and the Youden of 0.621. The model verification results showed the sensitivity of 0.667, the specificity of 0.955. Children undergoing surgery are at risk for developing delirium during the postoperative period, young age, developmental delay, otorhinolaryngology surgery, pain, and exposure to dexmedetomidine were associated with increased odds of delirium. Our study established a postoperative delirium prediction model for pediatric patients, which may be a base for development of strategies to prevent and treat postoperative delirium in children.

show abstract

Risk Factors for the Development of Postoperative Delirium in Pediatric Intensive Care Patients

Abstract: A high prevalence of delirium was noted in the PICU, and several perioperative risk factors were identified. Our data may be a base for development of strategies to prevent and treat postoperative delirium in children.

Cited by 35 publications

References 30 publications

Publication bias in pediatric emergence delirium: a cross-sectional analysis of ClinicalTrials.gov and ClinicalTrialsRegister.eu

Publication bias in pediatric emergence delirium: a cross-sectional analysis of ClinicalTrials.gov and ClinicalTrialsRegister.eu

Unpublished clinical studies in pediatric emergence delirium – a cross sectional analysis

Development and validation of a postoperative delirium prediction model for pediatric patients

Contact Info

Product

Resources

About